太田痣激光治疗的疗效及其并发症色素脱失的影响因素研究

发布时间：2018-03-25 16:15

本文选题：太田痣　切入点：激光治疗　出处：《山东大学》2012年硕士论文

【摘要】：太田痣是临床常见的一种真皮层黑色素增多的疾病,常与三叉神经周围分支分布相一致,又被称为眼上颌青褐色痣。过去整形外科常采用皮肤磨削术、植皮术、化学剥脱术或冷冻疗法来治疗太田痣,由于创伤较大,均可能在局部造成明显的瘢痕或皮肤质地改变。近年来激光技术的发展,使得太田痣的治疗进入一个崭新的时期,它通过选择性光热作用清除皮肤中的黑色素颗粒,组织损伤轻微,疗效确切,目前己成为太田痣治疗的首选手段。但经过多年的临床实践,我们发现这一治疗方法也存在发生并发症的可能,影响临床效果和患者的满意度,值得我们去关注和加以研究。研究目的：探讨Q开关Nd:YAG激光和Q开关红宝石激光治疗太田痣患者的效果和影响治疗效果的相关因素,以及治疗后色素脱失这一重要并发症的发生率及其影响因素。方法：选择使用Q开关Nd:YAG激光和Q开关红宝石激光治疗的太田痣患者266例,进行长期随访,收集患者各项相关临床资料,通过两位未直接参与治疗的医师与患者共同评价治疗效果。将患者的各项临床特征资料运用逻辑回归方法进行相关性分析。通过手术获取色素脱失患者的色素脱失部位组织和周围太田痣组织样本,进行HE染色和免疫组化染色,并加以分析。结果：①随访结果：随访发现266例太田痣患者在经过4至13次激光治疗后,全部达到有效及有效以上的效果,其中,治愈者80人(占30.07%),显效者151人(占56.77%),仅达有效者35人(占13.16%)。另外,有40例患者在治疗过程中发生色素脱失,发生率为15.04%。②统计分析结果：经过统计学分析发现,激光的能量密度值、患者的首次治疗年龄、太田痣的治疗面积以及患者性别与色素脱失的发生具有相关性。③病理分析结果：HE染色发现,色素脱失部位黑色素颗粒基本完全消失,而周围太田痣皮肤的色素颗粒仍存在；免疫组化染色发现,色素脱失部位黑色素细胞数量较正常皮肤组织无明显改变,但其色素颗粒基本完全消失。结论及意义：激光治疗太田痣操作方便,疗效确定,不同类型的激光可针对不同颜色深度的病损,激光治疗过程中应根据病损区治疗反应、医师的临床经验和患者的病损部位等准确判断治疗应采用的激光型号及治疗能量密度等。激光治疗太田痣有其安全性,但是由于各种因素的综合作用,也可能导致少数患者发生并发症,其中以色素脱失最令患者难以接受。通过本研究我们发现,激光能量密度、首次治疗年龄、太田痣面积等因素影响色素脱失的发生,是激光治疗太田痣发生色素脱失的独立危险因素。年龄的增大和治疗次数的增多使疗效更加显著,同时也增加了发生色素脱失的危险性,因此在治疗时应在追求更好的疗效的同时兼顾并发症的发生。激光能量密度的调节应在治疗时根据实际治疗反应选择相对保守的能量密度。组织染色结果显示,激光治疗后与周边太田痣组织相比,色素脱失部位色素颗粒减少,而色素细胞的数量没有明显变化。因此,激光治疗是否对色素细胞的代谢功能产生永久性损伤,尚需进一步的研究和探讨。
[Abstract]:Ota is a common type of dermal melanin increased disease, often consistent with the distribution of the trigeminal nerve, also known as ophthalmic maxillary Green Brown nevus. Past plastic surgery often use dermabrasion, skin grafting, chemical peeling or freezing therapy for the treatment of nevus of Ota, due to severe trauma that may cause obvious scar or skin texture change in local. In recent years the development of laser technology, makes the treatment of nevus of Ota entered a new era, it is through selective photothermolysis to remove melanin granules in the skin, mild tissue damage, curative effect, and has become the preferred means of treatment of nevus of Ota but after years of clinical practice, we found that this treatment also exist complications, clinical effect and patient satisfaction, worthy of our attention and study.
Research purposes: To explore the effect of Q switch Nd:YAG laser and Q switch ruby laser in the treatment of nevus of Ota, and the related factors that influence the therapeutic effect, and the incidence and influencing factors of the important complication after treatment.
Methods: using the Q switch Nd:YAG laser and Q switched ruby laser in the treatment of 266 cases of patients with nevus of Ota, long-term follow-up, collect the clinical data of patients, by two is not directly involved in the treatment of both physicians and patients to evaluate the therapeutic effect of the patients. The clinical features of data using the logistic regression correlation analysis get organized. Depigmentation depigmentation sites in and around the patients with nevus of Ota tissue samples by operation, HE staining and immunohistochemical staining, and analyzed.
Results: the follow-up results: follow-up of 266 cases of nevus of Ota in patients after 4 to 13 times after the laser treatment, all achieve the effective and effective effect of more than 80 people, among them, the cure (30.07%), effective in 151 (56.77%), only 35 effective (13.16%). In addition, there are 40 cases of depigmentation in the course of treatment, the incidence rate was 15.04%. the results of statistical analysis: statistical analysis showed that the laser energy density, age of first treatment of patients with nevus of Ota treated area and gender and depigmentation patients associated with pathological analysis. Results: HE staining, depigmentation parts of melanin granules disappeared completely, and the pigment granules around nevus of Ota skin still exist; immunohistochemical staining showed that no significant change in the number of depigmentation parts of the melanocytes with normal skin tissue, but the pigment The particles basically disappeared completely.
Conclusion and significance: laser treatment of nevus of Ota determined curative effect, convenient operation, different types of laser for different color depth of the lesion area should be based on the treatment effects of laser treatment in the process of doctor's clinical experience and patient the lesion accurately determine the treatment should adopt the laser type and energy density of laser treatment. Treatment of nevus of Ota with its security, but due to various factors, may also lead to complications in a few patients, with depigmentation most patients to accept. Through this study we found that the laser energy density, age of first treatment, Tada nevus area and depigmentation factors are independent risk laser treatment of nevus of Ota and depigmentation. The increase of age and times of treatment increased more significant effect, but also increases the risk of depigmentation, So the treatment should be in the pursuit of better curative effect of both complications. Adjusting the laser energy density should be treated according to the actual treatment response to choose the conservative energy density. Tissue staining results show that, compared with the surrounding tissue after laser treatment of nevus of Ota, reduce the depigmentation parts of the pigment particles, while no significant changes the number of pigment cells. Therefore, whether the metabolic function of laser treatment of pigment cells causing permanent damage, still need further research and discussion.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R758.51

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